Journal of Experimental Social Psychology 46 (2010) 226–228

Contents lists available at ScienceDirect

Journal of Experimental Social Psychology

journal homepage: www.elsevier.com/locate/jesp

FlashReport

When the death makes you smoke: A terror management perspective

on the effectiveness of cigarette on-pack warnings
Jochim Hansen a,b,*, Susanne Winzeler b, Sascha Topolinski c
a
New York University, Department of Psychology, 6 Washington Place, New York, NY 10003, United States
b
University of Basel, Department of Psychology, Missionsstrasse 60/62, CH-4055 Basel, Switzerland
c
University of Würzburg, Lehrstuhl für Psychologie II, Röntgenring 10, D-97070 Würzburg, Germany

a r t i c l e i n f o a b s t r a c t

Article history: One of the principal vehicles for informing tobacco consumers about the risks of smoking is the warning
Received 16 July 2009 message on each cigarette package. Based on terror management theory, the present study investigates
Revised 11 September 2009 the impact of mortality-salient warnings on cigarette packages compared to warnings with no mortality
Available online 18 September 2009
threat. Results suggest that to the degree that smoking is a source of self-esteem, later attitudes towards
smoking become more positive if the warning message is mortality-salient. On the contrary, if the warn-
Keywords: ing is terrifying but not mortality-salient and relates to the source of self-esteem, smoking attitudes
Terror management health model
become more negative with higher smoking-based self-esteem. Thus, mortality-salient warnings may
Terror management theory
Smoking
increase the tendency to favor smoking under certain circumstances. This fatal ironic effect highlights
Warning message the importance of a risk communication that matches the self-esteem contingencies of the recipients,
Mortality salience and it has urgent implications for health care policy.
Self-esteem Ó 2009 Elsevier Inc. All rights reserved.

Smoking is responsible for millions of deaths all over the world;
and the figure is estimated to continue to rise (US Department of
Health, 2004). In an effort to help to reduce the number of tobacco
consumers, governments started several anti-smoking strategies,
such as raising the taxation on tobacco products, publicizing
anti-smoking advertisements, or making certain public places
smoke-free.
Labeling of tobacco products is yet another anti-smoking strat-
egy. In many countries, every tobacco product has to have a mes-
sage printed on the package that warns against the negative
consequences of smoking for one’s health. Such warnings shall
make consumers aware that smoking leads to death (e.g., ‘‘Smok-
ing kills”), to health problems (e.g., ‘‘Smoking clogs the arteries
and causes heart attacks and strokes”), and to social problems
(e.g., ‘‘Protect children: Do not make them breath your smoke”).
Thereby, many of such warning messages remind us of our mortal-
ity, but others do not (e.g., ‘‘Smoking makes your skin age
quicker”). How effective are such warnings in reducing smoking
attitudes?
In the present research, we hypothesize that warning messages
may have different effects on smoking attitudes, depending on (1)
how salient mortality is in the messages, and on (2) how strongly
recipients base their self-esteem on smoking. Specifically, we pro-
* Corresponding author. Address: Department of Psychology, New York Univer-
sity, 6 Washington Place, New York, NY 10003, United States.
E-mail address: jochim.hansen@nyu.edu (J. Hansen).
pose that, on the one hand, terrifying but death-unrelated warn-
ings (such as ‘‘Smoking brings you and the people around you
severe damage” and ‘‘Smoking makes you unattractive”) are effec-
tive in reducing attitudes towards smoking to a greater degree the
more people base their self-esteem on smoking. This is because
such warnings may challenge the very reason for smoking particu-
larly for those who believe that smoking allows them to feel valued
by others or to boost their positive self-image. Thus, a high smok-
ing-based self-esteem may make people especially susceptible for
information that undermines their self-esteem.
Based on the terror management health model (Goldenberg &
Arndt, 2008), we predict on the other hand that the opposite pat-
tern would emerge when the warnings are related to death and
therefore make mortality salient. That is, the more individuals base
their self-esteem on smoking, the more they would adopt a posi-
tive attitude towards smoking after being provided with mortal-
ity-salient warning messages because awareness of mortality
motivates self-esteem striving (Pyszczynski, Greenberg, Solomon,
Arndt, & Schimel, 2004). This hypothesis can be derived from terror
management theory (e.g., Greenberg, Solomon, & Pyszczynski,
1997; Solomon, Greenberg, & Pyszczynski, 1991), which is based
on the notion that all human beings are aware that their own death
is inevitable. This knowledge creates the potential for extreme anx-
iety (or terror) because of being helplessly exposed to this threat.
In order to manage this distress, people are motivated to maintain
faith in their cultural worldview and to keep a positive self-esteem
(i.e., they are motivated to increase the subjective belief that one is

0022-1031/$ - see front matter Ó 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.jesp.2009.09.007
 J. Hansen et al. / Journal of Experimental Social Psychology 46 (2010) 226–228
a valuable member of one’s culture). Keeping a positive self-esteem
can give a feeling of security and function to buffer people from the
deeply rooted existential fear when mortality is made salient
(Pyszczynski et al., 2004). To the extent that smoking is a source
of self-esteem, mortality-salient on-pack warnings would thus
ironically cause more positive attitudes towards smoking.
A comparable example for the buffer function of self-esteem has
been shown by an experiment that examined the effects of mortality
salience on risk taking while driving (Taubman Ben-Ari, Florian, &
Mikulincer, 1999; see also Jessop, Alberty, Rutter, & Garrod, 2008).
Mortality salience inductions led to more risky driving than the con-
trol condition among individuals who perceived driving as relevant
to their self-esteem. Similarly, it has been demonstrated that wo-
men for whom their looks were an important source of self-esteem
preferred to eat fruit salad (compared to chocolate cake) if mortality
was salient, whereas women who based their self-esteem on other
things showed the opposite pattern (Ferraro, Shiv, & Bettman, 2005).
In the present research, we assessed smoking-based self-esteem
and afterwards presented smokers with fear-evoking warning
messages on cigarette packages. These warnings were either re-
lated to death or not. After a delay, we measured smoking atti-
tudes. We included a delay because any effects of mortality
threats can only be found when death-related thoughts have been
removed from conscious awareness, either by delay, by distraction,
or by subliminal presentation of the mortality threats (Goldenberg
& Arndt, 2008; Greenberg, Pyszczynski, Solomon, Simon, & Breus,
1994). When thoughts of death are in focal attention, behavior is
guided by a motivation to overcome these thoughts. Only after
thoughts of death have become nonconscious, motivations to bol-
ster one’s self-esteem may override such proximal defenses.
Because reminders of one’s mortality may lead to attempts to
bolster one’s self-esteem in response to an existential threat, we
predicted that mortality salience would paradoxically cause more
positive smoking attitudes for individuals who build their self-es-
teem on smoking. Therefore, death-related anti-smoking warnings
should be less effective in changing smoking attitudes the more
people base their self-esteem on smoking. In contrast, death–neu-
tral (but self-esteem related) anti-smoking warnings should more
effectively induce anti-smoking attitudes the more smoking is a
source of self-esteem.
Method
Participants and design
Thirty-nine psychology students who indicated that they were
smokers took part in the study in exchange for course credit (31
female, 8 male). Age ranged from 17 to 41 years (M = 22.46,
SD = 4.603, Mdn = 21). They were randomly assigned to one of two
experimental conditions (mortality salience vs. control).1 The two
conditions did not differ in the amount of smoking per day,
t(37) = 1.223, p = .26.
Materials and procedure
After providing some demographic data, participants filled in a
series of questionnaires. The first questionnaire measured to what
degree participants based their self-esteem on smoking with 12
items that were adapted from Taubman Ben-Ari et al. (1999),
and included the following examples: ‘‘Smoking brings out un-
wanted aspects of my character” (reversed scored), ‘‘Smoking dam-
1
Furthermore, we varied whether the warning messages contained pictures that
additionally emphasized the warning or not. However, this variation of the
presentation format had no effect on the attitudes, nor did it qualify the found
effects. Therefore, it is not discussed further.
227
ages my positive self-image” (reversed scored), ‘‘Smoking allows
me to feel valued by others,” and ‘‘Smoking allows me to feel wor-
thy.” For each statement, participants indicated their agreement on
a scale ranging from 1 (do not agree at all) to 7 (agree completely).
We calculated a mean smoking-based self-esteem index for each
participant (Cronbach’s a = .79). After this scale, participants
worked on a filler questionnaire.
Next, participants were randomly assigned to one of two condi-
tions. In both conditions we presented illustrations of two cigarette
packs, each of which contained an anti-smoking warning message.
In one condition, mortality was made salient by using warnings that
read, ‘‘Smokers die earlier” and ‘‘Smoking leads to deadly lung can-
cer.” In the other version, the warnings were unrelated to death
(i.e., ‘‘Smoking brings you and the people around you severe dam-
age” and ‘‘Smoking makes you unattractive”). A pretest with an inde-
pendent sample of 23 smokers had revealed that these two versions
were comparably threatening, t < 1, scary, t(21) = 1.843, p = .19, dis-
turbing, t(21) = 1.902, p = .18, and self-relevant, t < 1, but differed in
the degree to which they remind perceivers of the death as intended,
t(21) = 7.666, p = .01. In order to make sure that participants attend
to the packages, they were asked to write down three thoughts that
came to their mind when they saw the illustrations.
After this, participants filled in an unrelated questionnaire that
was included to introduce a 15-min delay between exposure of the
warnings and the dependent measure. This was done because pre-
vious research has shown that effects of mortality salience emerge
not until death-related thoughts have been removed from con-
scious awareness (Arndt, Greenberg, & Cook, 2002; Pyszczynski,
Greenberg, & Solomon, 1999).
Subsequently, smoking attitudes were collected with five items
that were answered on respective 7-point scales (‘‘Do you enjoy
smoking?” ‘‘How important is smoking for you?” ‘‘Do you intent
to smoke more or less in the future?” ‘‘Do you intent to quit smok-
ing in the future?” and ‘‘Are you going to smoke a cigarette directly
after this study?”). Finally, participants were thanked, debriefed,
and given credit.
Results
Preliminary analyses revealed that the mortality salience and
the control conditions did not differ significantly regarding
smoking-based self-esteem, (Mmortality salience = 2.25, SD = .84 vs.
Mcontrol condition = 2.32, SD = .81), t(37) = .28, p = .78, and smoking
attitudes (Mmortality salience = 4.24, SD = 1.06 vs. Mcontrol condition =
3.93, SD = 1.00), t(37) = –.948, p = .349.
To test the hypothesis that smoking-based self-esteem moder-
ates the effect of mortality salience on smoking attitudes and
intentions, we regressed the attitude score on the experimental
condition (0 = mortality salience condition, 1 = control condition),
the z-standardized smoking-based self-esteem score and their
two-way interaction. The main effect of condition was not signifi-
cant, b = .16, t(36) = .94, p = .35, indicating a similar overall smok-
ing attitude in both conditions. Importantly, the interaction
between the experimental condition and the smoking-based self-
esteem was significant, b = .63, t(36) = 2.88, p < .01 (see Fig. 1). As
hypothesized, simple slope tests (Aiken & West, 1991) revealed
that the smoking-based self-esteem was negatively related to
smoking attitudes in the control condition, b = –.45, t(36) = –2.02,
p = .05, but that it was positively related to smoking attitudes
when mortality was salient, b = .42, t(36) = 2.05, p < .05.
Discussion
The present findings suggest that warning messages on ciga-
rette packages can be effective in inducing anti-smoking attitudes.
228 J. Hansen et al. / Journal of Experimental Social Psychology 46 (2010) 226–228
Fig. 1. Attitudes towards smoking after anti-smoking warnings as a function of
mortality salience of the warnings and smoking-based self-esteem (±1 SD). The
mean attitude score ranged from 1 to 7; higher values indicate a more positive
attitude towards smoking.
However, their effect depends on a combination of smoking-based
self-esteem and mortality salience of the message. On the one
hand, death-related warnings were not effective and even ironi-
cally caused more positive smoking attitudes among tobacco con-
sumers who based their self-esteem on smoking. This finding
suggests that individuals with a high smoking self-esteem use po-
sitive smoking attitudes as a strategy to buffer against existential
fears provoked by the death-related warning messages. For indi-
viduals with a low smoking self-esteem, in contrast, a positive atti-
tude towards smoking would not buffer against existential terror.
Thus, relative to high smoking self-esteem participants, partici-
pants with a low smoking self-esteem demonstrated lower smok-
ing attitudes.2
On the other hand, warning messages that were unrelated to
death effectively reduced smoking attitudes the more recipients
based their self-esteem on smoking. This finding can be explained
by the fact that warnings such as ‘‘Smoking brings you and the peo-
ple around you severe damage” and ‘‘Smoking makes you unattrac-
tive” may be particularly threatening to people who believe the
opposite, namely that smoking allows them to feel valued by oth-
ers or to boost their positive self-image. To the degree that warning
messages undermine the high smoking-based self-esteem, smok-
ing may be devalued. Interestingly, this effect, too, only emerges
when attitudes are assessed after a delay but not when attitudes
are assessed directly after the warning (see Footnote 2). Possibly,
when smokers are consciously aware of warnings that argue
against the basis of their self-esteem, such warnings may be down-
played. After a delay, however, the warnings are not in conscious
awareness anymore and may unfold their impact.
In sum, consistent with the terror management theory (Green-
berg et al., 1997; Solomon et al., 1991) and the terror management
health model (Goldenberg & Arndt, 2008), the impact of warning
messages on cigarette packs depended (1) on the degree to which
self-esteem was based on smoking, and (2) on the salience of death
in the warnings. Our finding is of high practical relevance, as it sug-
gests that a differential strategy should be applied to warn smokers
against negative consequences of smoking, depending on the de-
gree to which they base their self-esteem on smoking. Death-re-
lated warnings are not effective and even have unwanted effects
when smokers have a high smoking-based self-esteem.
However, outside the laboratory, the degree to which smokers
base their self-esteem on smoking is unknown. Thus, it is difficult
2
Please note that this effect only emerged when attitudes had been assessed after a
delay. In a different study in which attitudes were measured directly after the
manipulation of mortality salience, we did not find any evidence for the influence of
mortality salience, smoking-based self-esteem, and their interaction on smoking
attitudes, ts < 1. This finding is in accordance with the terror management health
model (Goldenberg & Arndt, 2008).
to predict whether a death-related or a death-unrelated warning
message would be more effective. Yet, one could speculate that
certain populations base their self-esteem on smoking to a higher
degree than others, for instance young smokers who want to im-
press their peers. If this turns out to be true, a consequence of
our findings would be that such populations should be warned
against noxious consequences of smoking with death–neutral mes-
sages that undermine their smoking-based self-esteem. Such mes-
sages would probably not increase smoking attitudes as a strategy
to buffer against existential fears, but instead change people’s
minds after a delay.
In general, when smokers are faced with death-related anti-
smoking messages on cigarette packs, they produce active coping
attempts as reflected in their willingness to continue the risky
smoking behavior. Which coping attempt they use, depends on
their smoking-based self-esteem. To succeed with anti-smoking
messages on cigarette packs one thus has to take into account that
considering their death may make people smoke.
Acknowledgment
We thank Malte Friese for helpful comments on an earlier ver-
sion of this article.
References
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting
interactions. Newbury Park, CA: Sage.
Arndt, J., Greenberg, J., & Cook, A. (2002). Mortality salience and the spreading
activation of world-view relevant constructs: Exploring the cognitive
architecture of terror management. Journal of Experimental Psychology:
General, 131, 307–324.
Ferraro, R., Shiv, B., & Bettman, J. R. (2005). Let us eat and drink, for tomorrow we
shall die: Effects of mortality salience and self-esteem on self-regulation in
consumer choice. Journal of Consumer Research, 32, 65–75.
Goldenberg, J. L., & Arndt, J. (2008). The implications of death for health: A terror
management health model for behavioral health promotion. Psychological
Review, 115, 1032–1053.
Greenberg, J., Pyszczynski, T., Solomon, S., Simon, L., & Breus, M. (1994).
Role of consciousness and accessibility of death-related thoughts in
mortality salience effects. Journal of Personality and Social Psychology, 67,
627–637.
Greenberg, J., Solomon, S., & Pyszczynski, T. (1997). Terror management theory of
self-esteem and cultural worldviews: Empirical assessments and conceptual
refinements. In M. Zanna (Ed.). Advances in experimental social psychology (Vol.
29, pp. 61–139). San Diego, CA: Academic Press.
Jessop, D. C., Alberty, I. P., Rutter, J., & Garrod, H. (2008). Understanding the impact
of mortality-related health-risk information: A terror management theory
perspective. Personality and Social Psychology Bulletin, 34, 951–964.
Pyszczynski, T., Greenberg, J., & Solomon, S. (1999). A dual-process model of
defense against conscious and unconscious death-related thoughts: An
extension of terror–management theory. Psychological Review, 106,
835–845.
Pyszczynski, T., Greenberg, J., Solomon, S., Arndt, J., & Schimel, J. (2004). Why do
people need self-esteem? A theoretical and empirical review. Psychological
Bulletin, 130, 435–468.
Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). A terror management theory of
social behaviour: The functions of self-esteem and cultural worldviews. In M.
Zanna (Ed.). Advances in experimental social psychology (Vol. 24, pp. 93–159).
San Diego, CA: Academic Press.
Taubman Ben-Ari, O., Florian, V., & Mikulincer, M. (1999). The impact of mortality
salience on reckless driving: A terror management mechanism. Journal of
Personality and Social Psychology, 76, 35–45.
US Department of Health and Human Services (2004). The health consequences of
smoking: A report of the surgeon general. Atlanta, GA: US Department of Health
and Human Services, Centers for Disease Control and Prevention, National
Center for Chronic Disease Prevention and Health Promotion, Office on Smoking
and Health.